胃癌穿孔患者术后预后影响因素分析

Factors Influencing the Post-operative Survival in Patients with Perforated Gastric Cancer

目的了解胃癌穿孔患者术后的生存情况,探讨影响预后的相关因素。方法采用Cox模型回顾性分析2000年7月—2011年7月收治的61例胃癌穿孔术患者的临床资料。结果患者术后中位生存时间120 d。1、3、5年生存率分别是31.15%(19/61)、3.28%(2/61)和0。对单因素Cox回归分析筛选差异有统计学意义的变量进行多因素Cox回归分析显示,与Ⅱ期胃癌比较,Ⅲ期(OR=4.875,P=0.040)和Ⅳ期(OR=9.386,P=0.006)胃癌穿孔患者的预后差。与一期根治术相比,行单纯修补术(OR=3.937,P=0.008)和姑息性胃切除术(OR=2.347,P=0.031)患者的预后较差。此外,合并疾病也是预后的危险因素(OR=4.337,P=0.002)。结论胃癌穿孔患者术后的预后不良,与胃癌TNM分期的关系最密切,手术方式首选一期根治术;而是否患有合并疾病是机体能否耐受手术的参考指标。

Objective To explore factors that influence the postoperative survival of patients with perforated gastric cancer.Methods The clinical data of 61 patients with perforated gastric cancer who underwent emergency surgery from July 2000 to July 2011 were retrospectively analyzed by Cox proportional hazards model.Results The median postoperative survival was 120d,and the 1-,3,and 5-year survival rate was 31.15%（19/61）,3.28%（2/61）,and 0,respectively.The multivariant Cox analysis was applied to evaluate the predictors of perforation,which was screened initially by univariate Cox analysis in terms of statistical significance.The most significant predictor of perforation prognosis was the stage of stomach cancer：compared with Stage Ⅱ,the prognoses of stage Ⅲ（OR=4.875,P=0.040） and stage Ⅳ（OR=9.386,P=0.006） were worse.Compared to the radical gastrectomy,the prognoses of prime repair（OR=3.937,P=0.008） and palliative surgery（OR=2.347,P=0.031） were worse（P0.05）.Furthermore,comorbidity was also a predictor（OR=0.046,P0.001）.Conclusion Patients with perforated gastric cancer have poor prognosis,which is most closely related to the cancer stage.One-stage radical gastrectomy should be recommended as the first choice.The option of surgery must be prudent for patients with comorbidity.